Remote Monitoring in Heart Failure: Recent Trends and Future Perspectives
Main Article Content
Abstract
Heart failure is linked to serious health problems, high medical expenses, and fatality. A promising approach to enhance the clinical care of heart failure patients and intervene prior to an overt decompensation is remote monitoring technology. Remote Monitoring technologies have shown potential in managing and carrying out medical therapy to improve the health and outcomes for heart failure patients. This review highlights the evidence on currently available remote monitoring technologies and avenues for heart failure patients and discusses the benefits and gaps thereof. The paper specifically focuses on the different categories of interventions, namely technology based, care-program based or a combination of the two, and delves into their outcomes and limitations. Out of the 47 publications included with a minimum sample size of 104 patients, 37 papers demonstrated successful patient compliance and clinical outcomes, while 10 papers hardly demonstrated any successful outcomes. Studies have shown that the use of remote patient monitoring devices lowers patient mortality and re-hospitalization rates while reducing hospitalisations by more than 65%. According to the review research, short- to medium-term advantages such as higher survival rates, lower hospital utilisation, and lower costs are mostly maintained over time. The results demonstrated that patients who used a hybrid (which included both care and technology) strategy of virtual, in-person, and asynchronous care had more convenience, access, improved clinical outcomes, and overall Quality of Life.In addition to these results, remote cardiac monitoring has also been associated with significant cost reductions.
Article Details
How to Cite
SHAH, Dr. Ruchit et al.
Remote Monitoring in Heart Failure: Recent Trends and Future Perspectives.
Medical Research Archives, [S.l.], v. 11, n. 1, jan. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3489>. Date accessed: 19 apr. 2024.
doi: https://doi.org/10.18103/mra.v11i1.3489.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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3. Desai AS, Stevenson LW. Rehospitalization for heart failure: predict or prevent? Circulation. 2012;126(4):501-506. doi:10.1161/CIRCULATIONAHA.112.125435
4. Sahandi R, Noroozi S, Roushan G, Heaslip V, Liu Y. Wireless technology in the evolution of patient monitoring on general hospital wards. J Med Eng Technol. 2010;34(1):51-63. doi:10.3109/03091900903336902
5. Krzesiński P, Jankowska EA, Siebert J, et al. Effects of an outpatient intervention comprising nurse-led non-invasive assessments, telemedicine support and remote cardiologists’ decisions in patients with heart failure (AMULET study): a randomised controlled trial. Eur J Heart Fail. 2022;24(3):565-577. doi:10.1002/ejhf.2358
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7. Ong MK, Romano PS, Edgington S, et al. Effectiveness of Remote Patient Monitoring After Discharge of Hospitalized Patients With Heart Failure: The Better Effectiveness After Transition -- Heart Failure (BEAT-HF) Randomized Clinical Trial. JAMA Intern Med. 2016;176(3):310-318. doi:10.1001/jamainternmed.2015.7712
8. Dunbar SB, Reilly CM, Gary R, et al. Randomized clinical trial of an integrated self-care intervention for persons with heart failure and diabetes: quality of life and physical functioning outcomes. J Card Fail. 2015;21(9):719-729. doi:10.1016/j.cardfail.2015.05.012
9. Luttik MLA, Jaarsma T, van Geel PP, et al. Long-term follow-up in optimally treated and stable heart failure patients: primary care vs. heart failure clinic. Results of the COACH-2 study. Eur J Heart Fail. 2014;16(11):1241-1248. doi:10.1002/ejhf.173
10. Haynes SC, Tancredi DJ, Tong K, et al. The Effect of Rehospitalization and Emergency Department Visits on Subsequent Adherence to Weight Telemonitoring. J Cardiovasc Nurs. 2021;36(5):482-488. doi:10.1097/JCN.0000000000000689
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12. Möckel M, Koehler K, Anker SD, et al. Biomarker guidance allows a more personalized allocation of patients for remote patient management in heart failure: results from the TIM-HF2 trial. Eur J Heart Fail. 2019;21(11):1445-1458. doi:10.1002/ejhf.1530
13. Brons M, Rutten FH, Zuithoff NPA, Oerlemans MIFJ, Asselbergs FW, Koudstaal S. Disease management with home telemonitoring aimed at substitution of usual care in the Netherlands: Post-hoc analyses of the e-Vita HF study. J Cardiol. 2022;79(1):1-5. doi:10.1016/j.jjcc.2021.08.003
14. Maisel AS, Shah KS, Barnard D, et al. How B-Type Natriuretic Peptide (BNP) and Body Weight Changes Vary in Heart Failure With Preserved Ejection Fraction Compared With Reduced Ejection Fraction: Secondary Results of the HABIT (HF Assessment With BNP in the Home) Trial. J Card Fail. 2016;22(4):283-293. doi:10.1016/j.cardfail.2015.09.014
15. McDonald K, Troughton R, Dahlström U, et al. Daily home BNP monitoring in heart failure for prediction of impending clinical deterioration: results from the HOME HF study. Eur J Heart Fail. 2018;20(3):474-480. doi:10.1002/ejhf.1053
16. Maisel A, Barnard D, Jaski B, et al. Primary results of the HABIT Trial (heart failure assessment with BNP in the home). J Am Coll Cardiol. 2013;61(16):1726-1735. doi:10.1016/j.jacc.2013.01.052
17. Feijó MK, Ruschel KB, Bernardes D, et al. Effects of a diuretic adjustment algorithm protocol on heart failure admissions: A randomized clinical trial. J Telemed Telecare. 2021;27(5):288-297. doi:10.1177/1357633X211009640
18. Comín-Colet J, Enjuanes C, Verdú-Rotellar JM, et al. Impact on clinical events and healthcare costs of adding telemedicine to multidisciplinary disease management programmes for heart failure: Results of a randomized controlled trial. J Telemed Telecare. 2016;22(5):282-295. doi:10.1177/1357633X15600583
19. Jayaram NM, Khariton Y, Krumholz HM, et al. Impact of Telemonitoring on Health Status. Circ Cardiovasc Qual Outcomes. 2017;10(12). doi:10.1161/CIRCOUTCOMES.117.004148
20. Cichosz SL, Udsen FW, Hejlesen O. The impact of telehealth care on health-related quality of life of patients with heart failure: Results from the Danish TeleCare North heart failure trial. J Telemed Telecare. 2020;26(7-8):452-461. doi:10.1177/1357633X19832713
21. Bikdeli B, Wayda B, Bao H, et al. Place of residence and outcomes of patients with heart failure: analysis from the telemonitoring to improve heart failure outcomes trial. Circ Cardiovasc Qual Outcomes. 2014;7(5):749-756. doi:10.1161/CIRCOUTCOMES.113.000911
22. Frederix I, Vanderlinden L, Verboven AS, et al. Long-term impact of a six-month telemedical care programme on mortality, heart failure readmissions and healthcare costs in patients with chronic heart failure. J Telemed Telecare. 2019;25(5):286-293. doi:10.1177/1357633X18774632
23. Kotooka N, Kitakaze M, Nagashima K, et al. The first multicenter, randomized, controlled trial of home telemonitoring for Japanese patients with heart failure: home telemonitoring study for patients with heart failure (HOMES-HF). Heart Vessels. 2018;33(8):866-876. doi:10.1007/s00380-018-1133-5
24. Du H, Newton PJ, Budhathoki C, et al. The Home-Heart-Walk study, a self-administered walk test on perceived physical functioning, and self-care behaviour in people with stable chronic heart failure: A randomized controlled trial. Eur J Cardiovasc Nurs. 2018;17(3):235-245. doi:10.1177/1474515117729779
25. D’Onofrio A, Solimene F, Calò L, et al. Combining home monitoring temporal trends from implanted defibrillators and baseline patient risk profile to predict heart failure hospitalizations: results from the SELENE HF study. Europace. 2022;24(2):234-244. doi:10.1093/europace/euab170
26. de Ruvo E, Sciarra L, Martino AM, et al. A prospective comparison of remote monitoring systems in implantable cardiac defibrillators: potential effects of frequency of transmissions. J Interv Card Electrophysiol. 2016;45(1):81-90. doi:10.1007/s10840-015-0067-4
27. Boyne JJJ, Vrijhoef HJM, Spreeuwenberg M, et al. Effects of tailored telemonitoring on heart failure patients’ knowledge, self-care, self-efficacy and adherence: a randomized controlled trial. Eur J Cardiovasc Nurs. 2014;13(3):243-252. doi:10.1177/1474515113487464
28. Leng Chow W, Aung CYK, Tong SC, et al. Effectiveness of telemonitoring-enhanced support over structured telephone support in reducing heart failure-related healthcare utilization in a multi-ethnic Asian setting. J Telemed Telecare. 2020;26(6):332-340. doi:10.1177/1357633X18825164
29. Geller JC, Lewalter T, Bruun NE, et al. Implant-based multi-parameter telemonitoring of patients with heart failure and a defibrillator with vs. without cardiac resynchronization therapy option: a subanalysis of the IN-TIME trial. Clin Res Cardiol. 2019;108(10):1117-1127. doi:10.1007/s00392-019-01447-5
30. Sardu C, Santamaria M, Rizzo MR, et al. Telemonitoring in heart failure patients treated by cardiac resynchronisation therapy with defibrillator (CRT-D): the TELECART Study. Int J Clin Pract. 2016;70(7):569-576. doi:10.1111/ijcp.12823
31. Krum H, Forbes A, Yallop J, et al. Telephone support to rural and remote patients with heart failure: the Chronic Heart Failure Assessment by Telephone (CHAT) study. Cardiovasc Ther. 2013;31(4):230-237. doi:10.1111/1755-5922.12009
32. Jehn M, Prescher S, Koehler K, et al. Tele-accelerometry as a novel technique for assessing functional status in patients with heart failure: feasibility, reliability and patient safety. Int J Cardiol. 2013;168(5):4723-4728. doi:10.1016/j.ijcard.2013.07.171
33. Prescher S, Schoebel C, Koehler K, et al. Prognostic value of serial six-minute walk tests using tele-accelerometry in patients with chronic heart failure: A pre-specified sub-study of the TIM-HF-Trial. Eur J Prev Cardiol. 2016;23(2 suppl):21-26. doi:10.1177/2047487316671438
34. D’Onofrio A, Stabile G, Capucci A, et al. Association between remote implantable cardioverter defibrillator monitoring and beta-blocker utilization: An analysis from the EFFECT study. J Telemed Telecare. 2016;22(7):383-390. doi:10.1177/1357633X15613701
35. De Simone A, Leoni L, Luzi M, et al. Remote monitoring improves outcome after ICD implantation: the clinical efficacy in the management of heart failure (EFFECT) study. Europace. 2015;17(8):1267-1275. doi:10.1093/europace/euu318
36. Wintrich J, Pavlicek V, Brachmann J, et al. Remote Monitoring With Appropriate Reaction to Alerts Was Associated With Improved Outcomes in Chronic Heart Failure: Results From the OptiLink HF Study. Circ Arrhythm Electrophysiol. 2021;14(1):e008693. doi:10.1161/CIRCEP.120.008693
37. Böhm M, Drexler H, Oswald H, et al. Fluid status telemedicine alerts for heart failure: a randomized controlled trial. Eur Heart J. 2016;37(41):3154-3163. doi:10.1093/eurheartj/ehw099
38. Hindricks G, Taborsky M, Glikson M, et al. Implant-based multiparameter telemonitoring of patients with heart failure (IN-TIME): a randomised controlled trial. Lancet. 2014;384(9943):583-590. doi:10.1016/S0140-6736(14)61176-4
39. Boriani G, Da Costa A, Ricci RP, et al. The MOnitoring Resynchronization dEvices and CARdiac patiEnts (MORE-CARE) randomized controlled trial: phase 1 results on dynamics of early intervention with remote monitoring. J Med Internet Res. 2013;15(8):e167. doi:10.2196/jmir.2608
40. Indraratna, Biswas, McVeigh. A Smartphone-Based Model of Care to Support Patients With Cardiac Disease Transitioning From Hospital to the Community (TeleClinical Care): Pilot …. JMIR MHealth UHealth. https://mhealth.jmir.org/2022/2/e32554.
41. Dawson NL, Hull BP, Vijapura P, et al. Home Telemonitoring to Reduce Readmission of High-Risk Patients: a Modified Intention-to-Treat Randomized Clinical Trial. J Gen Intern Med. 2021;36(11):3395-3401. doi:10.1007/s11606-020-06589-1
42. Ding H, Jayasena R, Chen SH, et al. The Effects of Telemonitoring on Patient Compliance With Self-Management Recommendations and Outcomes of the Innovative Telemonitoring Enhanced Care Program for Chronic Heart Failure: Randomized Controlled Trial. J Med Internet Res. 2020;22(7):e17559. doi:10.2196/17559
43. Hofmann R, Völler H, Nagels K, et al. First outline and baseline data of a randomized, controlled multicenter trial to evaluate the health economic impact of home telemonitoring in chronic heart failure - CardioBBEAT. Trials. 2015;16:343. doi:10.1186/s13063-015-0886-8
44. Piotrowicz E, Pencina MJ, Opolski G, et al. Effects of a 9-Week Hybrid Comprehensive Telerehabilitation Program on Long-term Outcomes in Patients With Heart Failure: The Telerehabilitation in Heart Failure Patients (TELEREH-HF) Randomized Clinical Trial. JAMA Cardiol. 2020;5(3):300-308. doi:10.1001/jamacardio.2019.5006
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2. Cook C, Cole G, Asaria P, Jabbour R, Francis DP. The annual global economic burden of heart failure. Int J Cardiol. 2014;171(3):368-376. doi:10.1016/j.ijcard.2013.12.028
3. Desai AS, Stevenson LW. Rehospitalization for heart failure: predict or prevent? Circulation. 2012;126(4):501-506. doi:10.1161/CIRCULATIONAHA.112.125435
4. Sahandi R, Noroozi S, Roushan G, Heaslip V, Liu Y. Wireless technology in the evolution of patient monitoring on general hospital wards. J Med Eng Technol. 2010;34(1):51-63. doi:10.3109/03091900903336902
5. Krzesiński P, Jankowska EA, Siebert J, et al. Effects of an outpatient intervention comprising nurse-led non-invasive assessments, telemedicine support and remote cardiologists’ decisions in patients with heart failure (AMULET study): a randomised controlled trial. Eur J Heart Fail. 2022;24(3):565-577. doi:10.1002/ejhf.2358
6. Galinier M, Roubille F, Berdague P, et al. Telemonitoring versus standard care in heart failure: a randomised multicentre trial. Eur J Heart Fail. 2020;22(6):985-994. doi:10.1002/ejhf.1906
7. Ong MK, Romano PS, Edgington S, et al. Effectiveness of Remote Patient Monitoring After Discharge of Hospitalized Patients With Heart Failure: The Better Effectiveness After Transition -- Heart Failure (BEAT-HF) Randomized Clinical Trial. JAMA Intern Med. 2016;176(3):310-318. doi:10.1001/jamainternmed.2015.7712
8. Dunbar SB, Reilly CM, Gary R, et al. Randomized clinical trial of an integrated self-care intervention for persons with heart failure and diabetes: quality of life and physical functioning outcomes. J Card Fail. 2015;21(9):719-729. doi:10.1016/j.cardfail.2015.05.012
9. Luttik MLA, Jaarsma T, van Geel PP, et al. Long-term follow-up in optimally treated and stable heart failure patients: primary care vs. heart failure clinic. Results of the COACH-2 study. Eur J Heart Fail. 2014;16(11):1241-1248. doi:10.1002/ejhf.173
10. Haynes SC, Tancredi DJ, Tong K, et al. The Effect of Rehospitalization and Emergency Department Visits on Subsequent Adherence to Weight Telemonitoring. J Cardiovasc Nurs. 2021;36(5):482-488. doi:10.1097/JCN.0000000000000689
11. Haynes SC, Tancredi DJ, Tong K, et al. Association of Adherence to Weight Telemonitoring With Health Care Use and Death: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2020;3(7):e2010174. doi:10.1001/jamanetworkopen.2020.10174
12. Möckel M, Koehler K, Anker SD, et al. Biomarker guidance allows a more personalized allocation of patients for remote patient management in heart failure: results from the TIM-HF2 trial. Eur J Heart Fail. 2019;21(11):1445-1458. doi:10.1002/ejhf.1530
13. Brons M, Rutten FH, Zuithoff NPA, Oerlemans MIFJ, Asselbergs FW, Koudstaal S. Disease management with home telemonitoring aimed at substitution of usual care in the Netherlands: Post-hoc analyses of the e-Vita HF study. J Cardiol. 2022;79(1):1-5. doi:10.1016/j.jjcc.2021.08.003
14. Maisel AS, Shah KS, Barnard D, et al. How B-Type Natriuretic Peptide (BNP) and Body Weight Changes Vary in Heart Failure With Preserved Ejection Fraction Compared With Reduced Ejection Fraction: Secondary Results of the HABIT (HF Assessment With BNP in the Home) Trial. J Card Fail. 2016;22(4):283-293. doi:10.1016/j.cardfail.2015.09.014
15. McDonald K, Troughton R, Dahlström U, et al. Daily home BNP monitoring in heart failure for prediction of impending clinical deterioration: results from the HOME HF study. Eur J Heart Fail. 2018;20(3):474-480. doi:10.1002/ejhf.1053
16. Maisel A, Barnard D, Jaski B, et al. Primary results of the HABIT Trial (heart failure assessment with BNP in the home). J Am Coll Cardiol. 2013;61(16):1726-1735. doi:10.1016/j.jacc.2013.01.052
17. Feijó MK, Ruschel KB, Bernardes D, et al. Effects of a diuretic adjustment algorithm protocol on heart failure admissions: A randomized clinical trial. J Telemed Telecare. 2021;27(5):288-297. doi:10.1177/1357633X211009640
18. Comín-Colet J, Enjuanes C, Verdú-Rotellar JM, et al. Impact on clinical events and healthcare costs of adding telemedicine to multidisciplinary disease management programmes for heart failure: Results of a randomized controlled trial. J Telemed Telecare. 2016;22(5):282-295. doi:10.1177/1357633X15600583
19. Jayaram NM, Khariton Y, Krumholz HM, et al. Impact of Telemonitoring on Health Status. Circ Cardiovasc Qual Outcomes. 2017;10(12). doi:10.1161/CIRCOUTCOMES.117.004148
20. Cichosz SL, Udsen FW, Hejlesen O. The impact of telehealth care on health-related quality of life of patients with heart failure: Results from the Danish TeleCare North heart failure trial. J Telemed Telecare. 2020;26(7-8):452-461. doi:10.1177/1357633X19832713
21. Bikdeli B, Wayda B, Bao H, et al. Place of residence and outcomes of patients with heart failure: analysis from the telemonitoring to improve heart failure outcomes trial. Circ Cardiovasc Qual Outcomes. 2014;7(5):749-756. doi:10.1161/CIRCOUTCOMES.113.000911
22. Frederix I, Vanderlinden L, Verboven AS, et al. Long-term impact of a six-month telemedical care programme on mortality, heart failure readmissions and healthcare costs in patients with chronic heart failure. J Telemed Telecare. 2019;25(5):286-293. doi:10.1177/1357633X18774632
23. Kotooka N, Kitakaze M, Nagashima K, et al. The first multicenter, randomized, controlled trial of home telemonitoring for Japanese patients with heart failure: home telemonitoring study for patients with heart failure (HOMES-HF). Heart Vessels. 2018;33(8):866-876. doi:10.1007/s00380-018-1133-5
24. Du H, Newton PJ, Budhathoki C, et al. The Home-Heart-Walk study, a self-administered walk test on perceived physical functioning, and self-care behaviour in people with stable chronic heart failure: A randomized controlled trial. Eur J Cardiovasc Nurs. 2018;17(3):235-245. doi:10.1177/1474515117729779
25. D’Onofrio A, Solimene F, Calò L, et al. Combining home monitoring temporal trends from implanted defibrillators and baseline patient risk profile to predict heart failure hospitalizations: results from the SELENE HF study. Europace. 2022;24(2):234-244. doi:10.1093/europace/euab170
26. de Ruvo E, Sciarra L, Martino AM, et al. A prospective comparison of remote monitoring systems in implantable cardiac defibrillators: potential effects of frequency of transmissions. J Interv Card Electrophysiol. 2016;45(1):81-90. doi:10.1007/s10840-015-0067-4
27. Boyne JJJ, Vrijhoef HJM, Spreeuwenberg M, et al. Effects of tailored telemonitoring on heart failure patients’ knowledge, self-care, self-efficacy and adherence: a randomized controlled trial. Eur J Cardiovasc Nurs. 2014;13(3):243-252. doi:10.1177/1474515113487464
28. Leng Chow W, Aung CYK, Tong SC, et al. Effectiveness of telemonitoring-enhanced support over structured telephone support in reducing heart failure-related healthcare utilization in a multi-ethnic Asian setting. J Telemed Telecare. 2020;26(6):332-340. doi:10.1177/1357633X18825164
29. Geller JC, Lewalter T, Bruun NE, et al. Implant-based multi-parameter telemonitoring of patients with heart failure and a defibrillator with vs. without cardiac resynchronization therapy option: a subanalysis of the IN-TIME trial. Clin Res Cardiol. 2019;108(10):1117-1127. doi:10.1007/s00392-019-01447-5
30. Sardu C, Santamaria M, Rizzo MR, et al. Telemonitoring in heart failure patients treated by cardiac resynchronisation therapy with defibrillator (CRT-D): the TELECART Study. Int J Clin Pract. 2016;70(7):569-576. doi:10.1111/ijcp.12823
31. Krum H, Forbes A, Yallop J, et al. Telephone support to rural and remote patients with heart failure: the Chronic Heart Failure Assessment by Telephone (CHAT) study. Cardiovasc Ther. 2013;31(4):230-237. doi:10.1111/1755-5922.12009
32. Jehn M, Prescher S, Koehler K, et al. Tele-accelerometry as a novel technique for assessing functional status in patients with heart failure: feasibility, reliability and patient safety. Int J Cardiol. 2013;168(5):4723-4728. doi:10.1016/j.ijcard.2013.07.171
33. Prescher S, Schoebel C, Koehler K, et al. Prognostic value of serial six-minute walk tests using tele-accelerometry in patients with chronic heart failure: A pre-specified sub-study of the TIM-HF-Trial. Eur J Prev Cardiol. 2016;23(2 suppl):21-26. doi:10.1177/2047487316671438
34. D’Onofrio A, Stabile G, Capucci A, et al. Association between remote implantable cardioverter defibrillator monitoring and beta-blocker utilization: An analysis from the EFFECT study. J Telemed Telecare. 2016;22(7):383-390. doi:10.1177/1357633X15613701
35. De Simone A, Leoni L, Luzi M, et al. Remote monitoring improves outcome after ICD implantation: the clinical efficacy in the management of heart failure (EFFECT) study. Europace. 2015;17(8):1267-1275. doi:10.1093/europace/euu318
36. Wintrich J, Pavlicek V, Brachmann J, et al. Remote Monitoring With Appropriate Reaction to Alerts Was Associated With Improved Outcomes in Chronic Heart Failure: Results From the OptiLink HF Study. Circ Arrhythm Electrophysiol. 2021;14(1):e008693. doi:10.1161/CIRCEP.120.008693
37. Böhm M, Drexler H, Oswald H, et al. Fluid status telemedicine alerts for heart failure: a randomized controlled trial. Eur Heart J. 2016;37(41):3154-3163. doi:10.1093/eurheartj/ehw099
38. Hindricks G, Taborsky M, Glikson M, et al. Implant-based multiparameter telemonitoring of patients with heart failure (IN-TIME): a randomised controlled trial. Lancet. 2014;384(9943):583-590. doi:10.1016/S0140-6736(14)61176-4
39. Boriani G, Da Costa A, Ricci RP, et al. The MOnitoring Resynchronization dEvices and CARdiac patiEnts (MORE-CARE) randomized controlled trial: phase 1 results on dynamics of early intervention with remote monitoring. J Med Internet Res. 2013;15(8):e167. doi:10.2196/jmir.2608
40. Indraratna, Biswas, McVeigh. A Smartphone-Based Model of Care to Support Patients With Cardiac Disease Transitioning From Hospital to the Community (TeleClinical Care): Pilot …. JMIR MHealth UHealth. https://mhealth.jmir.org/2022/2/e32554.
41. Dawson NL, Hull BP, Vijapura P, et al. Home Telemonitoring to Reduce Readmission of High-Risk Patients: a Modified Intention-to-Treat Randomized Clinical Trial. J Gen Intern Med. 2021;36(11):3395-3401. doi:10.1007/s11606-020-06589-1
42. Ding H, Jayasena R, Chen SH, et al. The Effects of Telemonitoring on Patient Compliance With Self-Management Recommendations and Outcomes of the Innovative Telemonitoring Enhanced Care Program for Chronic Heart Failure: Randomized Controlled Trial. J Med Internet Res. 2020;22(7):e17559. doi:10.2196/17559
43. Hofmann R, Völler H, Nagels K, et al. First outline and baseline data of a randomized, controlled multicenter trial to evaluate the health economic impact of home telemonitoring in chronic heart failure - CardioBBEAT. Trials. 2015;16:343. doi:10.1186/s13063-015-0886-8
44. Piotrowicz E, Pencina MJ, Opolski G, et al. Effects of a 9-Week Hybrid Comprehensive Telerehabilitation Program on Long-term Outcomes in Patients With Heart Failure: The Telerehabilitation in Heart Failure Patients (TELEREH-HF) Randomized Clinical Trial. JAMA Cardiol. 2020;5(3):300-308. doi:10.1001/jamacardio.2019.5006
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